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1</a>&#41; with poor lymphocytes proliferation in response to mitogens&#46; Isohemagglutinins and response to vaccines were normal&#44; whereas bone marrow biopsy showed a mild dysplasia&#46; At the age of 21-years she developed pneumonia with severe sepsis&#44; and empirical antimicrobial therapy was started with improvement&#46; However&#44; chest computed tomography &#40;CT&#41; scan performed at 3-month follow-up showed thickened walled cavitary lesions on the right upper lobe&#44; bilateral bronchiectasis and bronchiolitis in the upper lobes&#46; Based on the clinical history and immune profile&#44; common variable immunodeficiency &#40;CVID&#41; was diagnosed&#44; and subcutaneous immunoglobulin &#40;Ig&#41; replacement therapy and co-trimoxazole prophylaxis were initiated&#46; Despite initial favourable response&#44; she later continued to experience intermittent cough&#44; shortness of breath and recurrent pneumonia&#46; At the age of 28 she was diagnosed with Pneumocystis Jiroveci and Cytomegalovirus pneumonia&#44; documented by microscopic examination of transbronchial lung biopsy specimens and broncho-alveolar lavage fluid &#40;BALF&#41; PCR&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0003" class="elsevierStylePara elsevierViewall">The patient was&#44; thus&#44; referred to our Unit&#46; Immunological investigations were hence repeated and confirmed persisting B-cell lymphopenia with normal Regulatory T cells&#46; Given the clinical history&#44; Signal Transducer and Activator of Transcription 1 &#40;STAT1&#41; disorder was suspected and confirmed by targeted DNA sequencing&#46; Namely&#44; genetic analysis identified a rare de novo heterozygous STAT1 gene mutation &#40;c&#46;520T&#62;C&#44; p&#46;Cys174Arg&#41;&#44; previously reported as a pathogenic gain of function &#40;GOF&#41; mutation&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">STAT1 plays a key role in orchestrating several pathways implicated in fundamental cellular processes&#44; including interferons &#945;&#47;&#946; signaling pathway&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> STAT1 GOF mutations lead to complex disorders characterized by great variability in the clinical manifestations&#46; Genetic-epigenetic factors may play a role in terms of clinical expression or onset timing&#44; and prompt diagnosis may be missed&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">In the largest cohort describing 274 patients with heterozygous GOF mutations&#44;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> the most common clinical feature was represented by fungal infections with CMC being the main manifestation at onset&#46; Autoimmune diseases were also documented &#40;43&#37;&#41;&#44; including T1D in 9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> The incidence of aneurysms as well as malignances affecting the skin&#44; larynx&#44; and gastrointestinal tract &#40;upper and lower&#41; was higher compared to standard population&#46;<a class="elsevierStyleCrossRefs" href="#bib0002"><span class="elsevierStyleSup">2-4</span></a> Low Respiratory Infections were reported in almost 50&#37;&#44; mainly bronchitis or interstitial pneumonia&#46; Whether or not bronchiectasis herein described is directly due to STAT1 signalling aberrance is not clear&#46; Actually the progressive worsening of the combined immunodeficiency observed in our patient may be identified as putative factor causing the occurrence of newly acquired infections&#46; Indeed&#44; bronchiectasis is the ultimate outcome of many conditions due to recurrent respiratory infections&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">A recent systematic review of 442 cases of STAT1 GOF mutations reported a higher risk of bronchiectasis in patients carrying the T385M mutation&#46; However&#44; our patients carried other type of mutation highlighting the need for proper microbiologic treatment in all patients with STAT1 GOF mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">The humoral immunodeficiency herein reported was observed as a rare immunological abnormality in patients with STAT1 GOF mutations&#46; Low B Lymphocytes or accelerated apoptosis in peripheral mature B-cells were described but the pathogenesis of impaired B cells response are still elusive&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">The uniqueness of the case here described resides in the challenging diagnosis due to additional clinical insights occurring over time&#44; eventually delineating a more comprehensive phenotype culminating only in adulthood &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#41;&#46; Although rare&#44; the association of bronchiectasis in a patient displaying humoral immunodeficiency&#44; opportunistic infections and autoimmune diseases&#44; should prompt physicians to investigate and underlying STAT1 signalling disorder&#46;</p><p id="para0009" class="elsevierStylePara elsevierViewall">Indeed&#44; early diagnosis may allow a dedicated multidisciplinary approach in order to reduce morbidity and mortality&#46; Hematopoietic stem cell transplantation has been performed in few patients and with inconsistent results and high mortality<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> and current treatment regimens are mainly supportive&#46; However&#44; recent novel treatment strategies targeting type I interferon signalling by systemic administration of JAK1 and JAK2 inhibitors have been successfully used in some patients&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Regarding our patient&#44; once the diagnosis was finalized&#44; we referred her back to adult specialists in order to attempt the newly identified JAK1&#47;2 inhibition therapeutical strategy&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Statement of Ethics</span><p id="para0010" class="elsevierStylePara elsevierViewall">Written informed consent was obtained from the patient for publication of this case report&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Funding</span><p id="para0011" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; 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                      "titulo" => "The extended clinical phenotype of 26 patients with chronic mucocutaneous candidiasis due to gain-of-function mutations in STAT1"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "S Fuchs"
                            2 => "J Raabe"
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                    ]
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                        "paginaFinal" => "84"
                        "link" => array:1 [
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical relevance of gain- and loss-of-function germline mutations in STAT1&#58; a systematic review"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W Zhang"
                            1 => "X Chen"
                            2 => "G Gao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Front Immunol"
                        "fecha" => "2021"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0005"
              "etiqueta" => "5"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gain-of-function STAT1 mutations are associated with PD-L1 overexpression and a defect in B-cell survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N Romberg"
                            1 => "H Morbach"
                            2 => "MG Lawrence"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2013.01.004"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Allergy Clin Immunol"
                        "fecha" => "2013"
                        "volumen" => "131"
                        "numero" => "6"
                        "paginaInicial" => "1691"
                        "paginaFinal" => "1693"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23403048"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A Kiykim"
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                            2 => "A Akcay"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Immunol"
                        "fecha" => "2019"
                        "volumen" => "39"
                        "numero" => "1"
                        "paginaInicial" => "37"
                        "paginaFinal" => "44"
                      ]
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              "etiqueta" => "7"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Precision therapy for the treatment of primary immunodysregulatory diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D Chellapandian"
                            1 => "M Chitty-Lopez"
                            2 => "JW&#46; Leiding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Immunol Allergy Clin North Am"
                        "fecha" => "2020"
                        "volumen" => "40"
                        "numero" => "3"
                        "paginaInicial" => "511"
                        "paginaFinal" => "526"
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Letter to the Editor
Recurrent pneumonia and severe opportunistic infections in declining immunity and autoimmune manifestations
Federica Zalloccoa, Alessia Omenettia, Venerino Polettib,c, Salvatore Cazzatoa,
Corresponding author
salvatore.cazzato@ospedaliriuniti.marche.it

Corresponding author at: Department: Department of Mother and Child Health, Institute/University/Hospital: Salesi Children's Hospital, Via Corridoni 11, Ancona 60123, Italy.
a Pediatric Unit, Dept of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
b Dept of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
c Dept of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
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1</a>&#41; with poor lymphocytes proliferation in response to mitogens&#46; Isohemagglutinins and response to vaccines were normal&#44; whereas bone marrow biopsy showed a mild dysplasia&#46; At the age of 21-years she developed pneumonia with severe sepsis&#44; and empirical antimicrobial therapy was started with improvement&#46; However&#44; chest computed tomography &#40;CT&#41; scan performed at 3-month follow-up showed thickened walled cavitary lesions on the right upper lobe&#44; bilateral bronchiectasis and bronchiolitis in the upper lobes&#46; Based on the clinical history and immune profile&#44; common variable immunodeficiency &#40;CVID&#41; was diagnosed&#44; and subcutaneous immunoglobulin &#40;Ig&#41; replacement therapy and co-trimoxazole prophylaxis were initiated&#46; Despite initial favourable response&#44; she later continued to experience intermittent cough&#44; shortness of breath and recurrent pneumonia&#46; At the age of 28 she was diagnosed with Pneumocystis Jiroveci and Cytomegalovirus pneumonia&#44; documented by microscopic examination of transbronchial lung biopsy specimens and broncho-alveolar lavage fluid &#40;BALF&#41; PCR&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0003" class="elsevierStylePara elsevierViewall">The patient was&#44; thus&#44; referred to our Unit&#46; Immunological investigations were hence repeated and confirmed persisting B-cell lymphopenia with normal Regulatory T cells&#46; Given the clinical history&#44; Signal Transducer and Activator of Transcription 1 &#40;STAT1&#41; disorder was suspected and confirmed by targeted DNA sequencing&#46; Namely&#44; genetic analysis identified a rare de novo heterozygous STAT1 gene mutation &#40;c&#46;520T&#62;C&#44; p&#46;Cys174Arg&#41;&#44; previously reported as a pathogenic gain of function &#40;GOF&#41; mutation&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">STAT1 plays a key role in orchestrating several pathways implicated in fundamental cellular processes&#44; including interferons &#945;&#47;&#946; signaling pathway&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> STAT1 GOF mutations lead to complex disorders characterized by great variability in the clinical manifestations&#46; Genetic-epigenetic factors may play a role in terms of clinical expression or onset timing&#44; and prompt diagnosis may be missed&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">In the largest cohort describing 274 patients with heterozygous GOF mutations&#44;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> the most common clinical feature was represented by fungal infections with CMC being the main manifestation at onset&#46; Autoimmune diseases were also documented &#40;43&#37;&#41;&#44; including T1D in 9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> The incidence of aneurysms as well as malignances affecting the skin&#44; larynx&#44; and gastrointestinal tract &#40;upper and lower&#41; was higher compared to standard population&#46;<a class="elsevierStyleCrossRefs" href="#bib0002"><span class="elsevierStyleSup">2-4</span></a> Low Respiratory Infections were reported in almost 50&#37;&#44; mainly bronchitis or interstitial pneumonia&#46; Whether or not bronchiectasis herein described is directly due to STAT1 signalling aberrance is not clear&#46; Actually the progressive worsening of the combined immunodeficiency observed in our patient may be identified as putative factor causing the occurrence of newly acquired infections&#46; Indeed&#44; bronchiectasis is the ultimate outcome of many conditions due to recurrent respiratory infections&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">A recent systematic review of 442 cases of STAT1 GOF mutations reported a higher risk of bronchiectasis in patients carrying the T385M mutation&#46; However&#44; our patients carried other type of mutation highlighting the need for proper microbiologic treatment in all patients with STAT1 GOF mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">The humoral immunodeficiency herein reported was observed as a rare immunological abnormality in patients with STAT1 GOF mutations&#46; Low B Lymphocytes or accelerated apoptosis in peripheral mature B-cells were described but the pathogenesis of impaired B cells response are still elusive&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">The uniqueness of the case here described resides in the challenging diagnosis due to additional clinical insights occurring over time&#44; eventually delineating a more comprehensive phenotype culminating only in adulthood &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#41;&#46; Although rare&#44; the association of bronchiectasis in a patient displaying humoral immunodeficiency&#44; opportunistic infections and autoimmune diseases&#44; should prompt physicians to investigate and underlying STAT1 signalling disorder&#46;</p><p id="para0009" class="elsevierStylePara elsevierViewall">Indeed&#44; early diagnosis may allow a dedicated multidisciplinary approach in order to reduce morbidity and mortality&#46; Hematopoietic stem cell transplantation has been performed in few patients and with inconsistent results and high mortality<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> and current treatment regimens are mainly supportive&#46; However&#44; recent novel treatment strategies targeting type I interferon signalling by systemic administration of JAK1 and JAK2 inhibitors have been successfully used in some patients&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Regarding our patient&#44; once the diagnosis was finalized&#44; we referred her back to adult specialists in order to attempt the newly identified JAK1&#47;2 inhibition therapeutical strategy&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Statement of Ethics</span><p id="para0010" class="elsevierStylePara elsevierViewall">Written informed consent was obtained from the patient for publication of this case report&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Funding</span><p id="para0011" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span></span>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec1"
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            0 => array:3 [
              "identificador" => "bib0001"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid activation by interferon alpha of a latent DNA-binding protein present in the cytoplasm of untreated cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "TC Dale"
                            1 => "AM Imam"
                            2 => "IM Kerr"
                            3 => "GR&#46; Stark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1073/pnas.86.4.1203"
                      "Revista" => array:7 [
                        "tituloSerie" => "Proc Nat Acad Sci USA"
                        "fecha" => "1989"
                        "volumen" => "86"
                        "numero" => "4"
                        "paginaInicial" => "1203"
                        "paginaFinal" => "1207"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2919169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0002"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heterozygous STAT1 gain-of-function mutations underlie an unexpectedly broad clinical phenotype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J Toubiana"
                            1 => "S Okada"
                            2 => "J Hiller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2015-11-679902"
                      "Revista" => array:7 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2016"
                        "volumen" => "127"
                        "numero" => "25"
                        "paginaInicial" => "3154"
                        "paginaFinal" => "3164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27114460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0003"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The extended clinical phenotype of 26 patients with chronic mucocutaneous candidiasis due to gain-of-function mutations in STAT1"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M Depner"
                            1 => "S Fuchs"
                            2 => "J Raabe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10875-015-0214-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Clin Immunol"
                        "fecha" => "2016"
                        "volumen" => "36"
                        "numero" => "1"
                        "paginaInicial" => "73"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26604104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0004"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical relevance of gain- and loss-of-function germline mutations in STAT1&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W Zhang"
                            1 => "X Chen"
                            2 => "G Gao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Front Immunol"
                        "fecha" => "2021"
                        "volumen" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gain-of-function STAT1 mutations are associated with PD-L1 overexpression and a defect in B-cell survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N Romberg"
                            1 => "H Morbach"
                            2 => "MG Lawrence"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2013.01.004"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Allergy Clin Immunol"
                        "fecha" => "2013"
                        "volumen" => "131"
                        "numero" => "6"
                        "paginaInicial" => "1691"
                        "paginaFinal" => "1693"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23403048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0006"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hematopoietic stem cell transplantation in patients with heterozygous STAT1 gain-of-function mutation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A Kiykim"
                            1 => "LM Charbonnier"
                            2 => "A Akcay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Immunol"
                        "fecha" => "2019"
                        "volumen" => "39"
                        "numero" => "1"
                        "paginaInicial" => "37"
                        "paginaFinal" => "44"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0007"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Precision therapy for the treatment of primary immunodysregulatory diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D Chellapandian"
                            1 => "M Chitty-Lopez"
                            2 => "JW&#46; Leiding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Immunol Allergy Clin North Am"
                        "fecha" => "2020"
                        "volumen" => "40"
                        "numero" => "3"
                        "paginaInicial" => "511"
                        "paginaFinal" => "526"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
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